Related Experiment Video
Updated: Mar 10, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Conventional Versus Prolonged Infusion of Meropenem in Neonates With Gram-negative Late-onset Sepsis: A Randomized
Abd Elazeez Shabaan1, Islam Nour, Heba Elsayed Eldegla
1From the *Neonatal Intensive Care Unit, Mansoura University Children's Hospital, †Department of Pediatrics, Faculty of Medicine, University of Mansoura, ‡Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Mansoura, and §Microbiology Diagnostics and Infection Control Unit, Mansoura University Hospitals, Mansoura, Egypt.
Background:
Gram-negative bacteria are associated with significant morbidity and mortality in preterm and term newborns. Meropenem has widespread efficacy and often allows for monotherapy in this group. Prolonged infusion instead of infusion over 30 minutes has been suggested to result in higher microbiologic efficacy.
Objective:
To compare the clinical and microbiologic efficacy and safety of prolonged infusions versus conventional dosing of meropenem in neonates with Gram-negative late-onset sepsis (GN-LOS).
Methods:
A prospective, randomized clinical trial was conducted in neonates with GN-LOS admitted to neonatal intensive care unit (NICU), Mansoura University Children's Hospital, between August 2013 and June 2015. Patients were randomly assigned to receive either intravenous infusion of meropenem over 4 hours (infusion group) or 30 minutes (conventional group) at a dosing regimen of 20 mg/kg/dose every 8 hours and 40 mg/kg/dose every 8 hours in meningitis and Pseudomonas infection. Clinical and microbiologic success in eradication of infection were the primary outcomes. Neonatal mortality, meropenem-related (MR) duration of mechanical ventilation, MR length of NICU stay, total length of NICU stay, duration of respiratory support (RS), duration of mechanical ventilation, MR duration of inotropes and adverse effects were secondary outcomes.
Results:
A total of 102 infants (51 in each group) were recruited. The infusion group demonstrated a significantly higher rate of clinical improvement and microbiologic eradication 7 days after starting meropenem therapy compared with the conventional group. Mortality and duration of RS were significantly less in the infusion group compared with conventional group. Acute kidney injury after meropenem treatment was significantly less in the infusion group compared with the conventional group.
Conclusions:
Prolonged infusion of meropenem in neonates with GN-LOS is associated with higher clinical improvement, microbiologic eradication, less neonatal mortality, shorter duration of RS and less acute kidney injury compared with the conventional strategy.
Insights
Prolonged meropenem infusions improve outcomes for neonatal Gram-negative late-onset sepsis (GN-LOS). This approach offers higher clinical and microbiologic efficacy, reduced mortality, and fewer complications compared to conventional dosing.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Gram-negative bacteria cause significant morbidity and mortality in newborns.
- Meropenem is a key antibiotic for neonatal infections, with prolonged infusion potentially enhancing efficacy.
- Gram-negative late-onset sepsis (GN-LOS) requires effective treatment strategies in neonates.
Purpose of the Study:
- To compare the clinical and microbiologic efficacy of prolonged meropenem infusions versus conventional dosing in neonates with GN-LOS.
- To evaluate the safety profile, including mortality and adverse events, of different meropenem infusion strategies.
Main Methods:
- A prospective, randomized clinical trial involving 102 neonates with GN-LOS.
- Patients received meropenem via prolonged infusion (4 hours) or conventional infusion (30 minutes).
- Primary outcomes included clinical and microbiologic eradication; secondary outcomes assessed mortality, NICU stay, and adverse effects.
Main Results:
- The prolonged infusion group showed significantly higher clinical improvement and microbiologic eradication rates.
- Neonatal mortality and duration of respiratory support were significantly lower in the prolonged infusion group.
- Fewer instances of acute kidney injury were observed with prolonged meropenem infusions.
Conclusions:
- Prolonged meropenem infusion is superior to conventional dosing for treating GN-LOS in neonates.
- This strategy leads to better clinical outcomes, reduced mortality, and a lower incidence of acute kidney injury.
- Extended meropenem infusions represent an improved therapeutic approach for neonatal sepsis.
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:15Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution